Pseudogout Flashcards
what is the definition of pseudogout?
Calcium pyrophosphate deposition (CPPD) is associated with both acute and chronic arthritis. Acute CPP crystal arthritis is an acute inflammatory arthritis of one or more joints. Knees, wrists, shoulders, ankles, elbows, or hands can be affected. The chronic form of CPP arthritis mimics osteoarthritis or rheumatoid arthritis and is associated with variable degrees of inflammation.
what is the epidemiology of pseudogout?
age increased incidence
what is the aetiology of pseudogout?
Unknown
The hallmark of the disease is the deposition of CPP crystals in the mid-zone of articular hyaline and fibro-cartilage. These crystals typically occur in the pericellular matrix around phenotypically altered articular chondrocytes. Factors that promote CPPD crystal formation include alterations in the structure and composition of the peri-cellular matrix and over-production of the pyrophosphate component of the CPPD crystal by chondrocytes. It is likely that chondrocyte phenotypic changes are initiated by ageing or injury and may be mediated through factors such as transforming growth factor-beta. The reasons behind the associations of the metabolic conditions with CPPD are not well understood.
what are the risk factors for pseudogout?
Advanced age Injury Hyperparathyroidism Haemochromatosis Family history Hypomagnesaemia Hypophosphatasia
what is the pathophysiology of pseudogout?
CPP crystals can be shed from cartilage into the articular space, where they may induce an inflammatory response and cause acute CPP arthritis. It has been speculated that crystal size and the nature of their adherent proteins may influence this process. In addition, CPP crystals can have direct catabolic effects on articular tissues. They can elicit the production of cytokines and proteases that degrade cartilage. They may also produce mechanical damage. It is likely that both inflammatory and non-inflammatory processes contribute to the severe joint degradation associated with articular CPP crystals.
what are the key presentations of pseudogout?
Presence of risk factors
Painful and tender joints
Osteoarthritis like involvement
Sudden worsening of osteoarthritis
what are the signs of pseudogout?
Osteoarthritis like involvement
Sudden worsening of osteoarthritis
Joint effusion
what are the symptoms of pseudogout?
Painful and tender joints
Red and swollen joints
Fever
Flatulence
what are the first line and gold standard investigations for pseudogout?
Arthrocentesis with synovial fluid analysis - intracellular or extracellular positively birefringent rhomboid-shaped crystals under polarised light confirms CPPD; fluids are often bloody
XRay - linear, stippled radio-opaque deposits in the fibro-cartilage or hyaline articular cartilage of joints, calcified tendons, subchondral cysts, progressive rapid joint degeneration or bony collapse, and predominant involvement of the patellofemoral joint in the knee suggests CPPD, chondrocalcinosis
Serum calcium - normal or elevated
Serum parathyroid hormone - normal or elevated
Iron studies - normal or elevated
Serum magnesium - normal or decreased
Serum alkaline phosphatase - normal or decreased
what are the differential diagnoses for pseudogout?
Acute gouty arthritis
Acute septic arthritis
Milwaukee shoulder syndrome
how is pseudogout managed?
Acute mono or oligo articular disease:
Intra-articular corticosteroids, paracetamol, NSAIDS, colchicine, systemic corticosteroids, combination analgesics, joint aspiration, splinting
Acute polyarticular disease:
NSAIDs, paracetamol, colchicine, systemic corticosteroids, intra-articular corticosteroids, combination analgesics, joint aspiration, splinting
Chronic:
Joint replacement surgery, paracetamol
(with RA or osteoarthritis) maintenance with colchicine and paracetamol
how is pseudogout monitored?
No specific monitoring for most patients with CPP arthritis is warranted. However, they should be monitored regularly for adverse effects of medicines
what are the complications of pseudogout?
Intra-articular corticosteroid- related adverse effects
what is the prognosis for pseudogout?
Many patients with acute CPP arthritis can expect significant improvement in their symptoms over days and weeks. An unknown percentage, however, will have recurrent disease.
